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ID PMID Title PublicationDate abstract
16099629 Novel therapies for rheumatoid arthritis. 2005 Oct Recent years have witnessed significant advancements in the therapeutic approach to rheumatoid arthritis. The introduction of biologic agents, in particular inhibitors of tumor necrosis factor (TNF), has ushered a new era in which the goal of therapy has become achieving very low levels of disease activity. Success achieved with the TNF inhibitors has reinvigorated research into targeting other componenets of the dysregulated immune system in RA. A number of approaches, targeting various cytokines, other inflammatory mediators, and populations of immunocompetent cells, seem promising.
16584079 Orthopedic surgical management of hip and knee involvement in patients with juvenile rheum 2006 Feb Juvenile rheumatoid arthritis is the most common arthritic disease of childhood and a leading cause of childhood disability, affecting an estimated 300,000 US children and adolescents aged < or =16 years. Approximately 10% to 30% of patients experience functional deficits resulting from both the articular and systemic manifestations of their disease, including leg length inequality and deformity, that are often more crippling than joint destruction. Surgical intervention to treat bone and soft-tissue deformity, leg length inequality, and joint destruction is indicated when medical therapy has failed. Synovectomy, soft-tissue release, osteotomy, and epiphysiodesis are used to treat deformity and early joint destruction. Arthroplasty remains the primary therapy for joint destruction, although it is fraught with complications specific to this young patient population.
21794301 [Atypical pulmonary nodules in a patient with rheumatoid arthritis]. 2006 Jan Rheumatoid arthritis (RA) is associated with a wide variety of lung manifestations, including rheumatoid nodules. We report the case of woman with a diagnosis of RA who underwent thoracic computed axial tomography (CAT) scan because of cough and effort dyspnea. The CAT scan revealed the presence of small lung nodules. After biopsy, these nodules were diagnosed as cholesterol granulomas.
16287591 Conventional x-ray in early arthritis. 2005 Nov This article reviews radiographic data from six cohorts of patients with early inflammatory arthritis. Of the patients, 8% to 15% had erosive disease at the first encounter with the rheumatologist. Classic scoring methods were applied to quantify damage, but baseline damage was low in early inflammatory arthritis. Yearly progression in damage score was assessed only in patients with high suspicion of rheumatoid arthritis at baseline or who had a final diagnosis of rheumatoid arthritis at follow-up and varied between 0.5% and 1.7% of the maximal damage of the scoring method per year. The large number of patients with zero values for erosions and lower progression rates will influence sample sizes in clinical trials in early inflammatory arthritis when including radiographic change as an outcome.
15758837 Sjögren syndrome associated with hepatitis C virus: a multicenter analysis of 137 cases. 2005 Mar To define the clinical and immunologic pattern of expression of Sjögren syndrome (SS) associated with chronic hepatitis C virus (HCV) infection, we conducted a multicenter study aiming to collect a large number of patients with SS and HCV infection. Inclusion criteria were the fulfillment of at least 4 of the classification criteria for SS proposed by the European Community Study Group and repeated positive HCV serology, confirmed by recombinant immunoblot assay and/or detection of serum HCV-RNA by polymerase chain reaction. One hundred thirty-seven patients were included (104 female and 33 male; mean age, 65 yr). Seventy-nine (58%) patients presented a systemic process with diverse extraglandular manifestations, with articular involvement (44%), vasculitis (20%), and neuropathy (16%) being the most frequent features observed. The main immunologic features were antinuclear antibodies (65%), hypocomplementemia (51%), and cryoglobulinemia (50%). Cryoglobulins were associated with a higher frequency of cutaneous vasculitis, rheumatoid factor, and hypocomplementemia. Thirty-two (23%) patients had positive anti-Ro/SS-A and/or anti-La/SS-B antibodies; these patients were predominantly women and had a higher prevalence of some extraglandular features and a lower frequency of liver involvement. Nineteen (14%) patients developed neoplasia, with hematologic neoplasia (8 cases) and hepatocellular carcinoma (6 cases) being the most frequent types. Eighty-five percent of SS-HCV patients also fulfilled the recently proposed 2002 classification criteria for SS. In conclusion, HCV-associated SS is indistinguishable in most cases from the primary form using the most recent set of classification criteria. Chronic HCV infection should be considered an exclusion criterion for the classification of primary SS, not because it mimics primary SS, but because the virus may be implicated in the development of SS in a specific subset of patients. We propose the term "SS secondary to HCV" when these patients fulfill the 2002 classification criteria for SS.
15711225 Dietary risk factors for rheumatic diseases. 2005 Mar PURPOSE OF REVIEW: Recent scientific data illuminate the dietary link to rheumatic disorders. This review summarizes recently published articles on the dietary link to rheumatoid arthritis, gout, and osteoarthritis. RECENT FINDINGS: A prospective study suggests that higher intakes of meat and total protein as well as lower intakes of fruit, vegetables, and vitamin C are associated with an increased risk of inflammatory polyarthritis or rheumatoid arthritis. Several studies suggest that the Mediterranean-type diet or its main components may have protective effects on the development or severity of rheumatoid arthritis. A recent prospective study investigated several purported dietary factors for gout and confirmed some of the long-standing suspicions (red meats, seafood, beer, and liquor), exonerated others (total protein, wine, and purine-rich vegetables), and also identified potentially new protective factors (dairy products). Recent double-blind, randomized, placebo-controlled studies suggest that antioxidant vitamins (vitamin E, vitamin C, beta-carotene, and retinol) do not halt the progression of symptomatic knee osteoarthritis, as was previously suggested. SUMMARY: Because diet is an unavoidable universal exposure for people, even a small effect that can be achieved by dietary manipulation may produce a large impact on the population's health. As the evidence on the role of dietary factors in rheumatic disorders grows it becomes increasingly important for clinicians and investigators in the field of rheumatology to familiarize themselves with the relevant data and appropriately apply them to clinical and public health practice.
16904039 [Presentation of a clinical case of systemic juvenile rheumatoid arthritis]. 2006 Jul A case of a 6-year-old male child was studied. Initially, he presented large-joint arthritis of the right knee and heel, with clinical data of systemic inflammation, such as fever, increase in sedimentation rate and leucocytosis, during more than six weeks of evolution. A wrong initial diagnosis of septic arthritis was made, but the lack of response to antibiotics and surgical drainage of the knee led to a trial with prednisone, which induced clinical remission. The patient remained hospitalized for 24 days and underwent surgical drainage, knee arthroscopy, two bone gammagrams, nuclear magnetic resonance, and antibiotics, as well as considerable stress and uncertainty for him and his family. Thus, it is very important to make an early diagnosis of juvenile rheumatoid arthritis and avoid complications. Recent literature was examined with special emphasis on opportune clinical diagnosis, as well as on therapeutic innovations, which have been able to modify the course of the disease and improve the quality of life of these patients. Pediatricians and general practitioners should take into account this diagnosis when seeing a patient with arthritis, especially when the signs point towards a systemic disease affecting two or more joints.
16699906 Off-label dermatologic uses of anti-TNF-a therapies. 2005 Dec BACKGROUND: Tumor necrosis factor-alpha (TNF-a) is a proinflammatory cytokine that plays an immunomodulatory role in a variety of systemic and dermatologic diseases. Currently, three anti-TNF-a drugs are available in North America- infliximab (approved in the U.S. for the treatment of rheumatoid arthritis, Crohn's disease, ankylosing spondylitis, ulcerative colitis, and psoriatic arthritis), etanercept (approved in the U.S. for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis), and adalimumab (approved for the treatment of rheumatoid arthritis and psoriatic arthritis). OBJECTIVE: To review the current literature supporting alternative (and currently off-label) dermatologic uses of TNF-a antagonists. METHODS: A MEDLINE search (1966-March 2005) was conducted using the keywords "infliximab," "etanercept," "adalimumab," "TNF inhibitors," and "off-label" to identify published reports of off-label dermatologic uses of TNF-a inhibitors. RESULTS: Anti-TNF-a therapies have been reported in the following dermatologic diseases: sarcoidosis, hidradenitis suppuritiva, cicatricial pemphigoid, Behçet's disease, pyoderma gangrenosum, multicentric reticulohistiocytosis, apthous stomatitis, Sneddon-Wilkinson disease, SAPHO syndrome, pityriasis rubra pilaris, eosinophilic fasciitis, panniculitis, Crohn's disease, necrobiosis lipoidica diabeticorum, dermatomyositis, and scleroderma. The vast majority of these reports are in the form of individual case reports and small case series. Only two published randomized controlled trials involving the off-label use of a TNF inhibitor were found. CONCLUSIONS: A growing number of published reports suggest that anti-TNF-a therapies may be effective in the treatment of numerous inflammatory skin diseases outside their currently approved indications.
16888192 VIP decreases TLR4 expression induced by LPS and TNF-alpha treatment in human synovial fib 2006 Jul It has been demonstrated that VIP produces beneficial effects both in a murine model of rheumatoid arthritis and in human rheumatoid synovial fibroblasts through the modulation of proinflammatory mediators. Toll-like receptors (TLRs) play a key role in the immediate recognition of microbial surface components by immune cells prior to the development of adaptative microbe-specific immune responses. In this study, we demonstrate that VIP decreases lipopolysaccharide (LPS) and TNF-alpha-induced expression of TLR4 and its correlation with the production of CCL2 and CXCL8 chemokines in human synovial fibroblasts from patients with rheumatoid arthritis and osteoarthritis. Our results add a new step for the use of VIP, as a promising candidate, for the treatment of rheumatoid arthritis.
16171986 Animal models of rheumatoid arthritis and their relevance to human disease. 2005 Oct Rodent models of rheumatoid arthritis (RA) are useful tools to study the pathogenic process of RA. Among the most widely used models of RA are the streptococcal cell wall (SCW) arthritis model and the collagen-induced arthritis (CIA). Both innate and adaptive immune mechanisms are involved in these rodent models. While no models perfectly duplicate the condition of human RA, they are easily reproducible, well defined and have proven useful for development of new therapies for arthritis, as exemplified by cytokine blockade therapies. Besides SCW and CIA models, there are numerous others including transgenic models such as K/BxN, induced models such as adjuvant-induced and pristane models, and spontaneous models in certain mouse strains, that have been used to help understand some of the underlying mechanisms. This review provides an update and analysis of RA models in mice and rats. The array of models has provided rheumatologists and immunologists a means to understand the multifactorial disease in humans, to identify new drug targets, and to test new therapies.
15843668 Leflunomide or methotrexate for juvenile rheumatoid arthritis. 2005 Apr 21 BACKGROUND: We compared the safety and efficacy of leflunomide with that of methotrexate in the treatment of polyarticular juvenile rheumatoid arthritis in a multinational, randomized, controlled trial. METHODS: Patients 3 to 17 years of age received leflunomide or methotrexate for 16 weeks in a double-dummy, blinded fashion, followed by a 32-week blinded extension. The rates of American College of Rheumatology Pediatric 30 percent responses (ACR Pedi 30) and the Percent Improvement Index were assessed at baseline and every 4 weeks for 16 weeks and every 8 weeks during the 32-week extension study. RESULTS: Of 94 patients randomized, 86 completed 16 weeks of treatment, 70 of whom entered the extension study. At week 16, more patients in the methotrexate group than in the leflunomide group had an ACR Pedi 30 response (89 percent vs. 68 percent, P=0.02), whereas the values for the Percent Improvement Index did not differ significantly (-52.87 percent vs. -44.41 percent, P=0.18). In both groups, the improvements achieved at week 16 were maintained at week 48. The most common adverse events in both groups included gastrointestinal symptoms, headache, and nasopharyngeal symptoms. Aminotransferase elevations were more frequent with methotrexate than with leflunomide during the initial study and the extension study. CONCLUSIONS: In patients with polyarticular juvenile rheumatoid arthritis, methotrexate and leflunomide both resulted in high rates of clinical improvement, but the rate was slightly greater for methotrexate. At the doses used in this study, methotrexate was more effective than leflunomide.
16287592 MRI and musculoskeletal ultrasonography as diagnostic tools in early arthritis. 2005 Nov Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium and is characterized by destruction of bone and cartilage. Early diagnosis and treatment of RA can improve disease outcomes substantially. Magnetic resonance imaging and musculoskeletal ultrasonography may facilitate early diagnosis and aid the targeting of intensive therapy. Magnetic resonance imaging and musculoskeletal ultrasonography also are able to monitor temporal changes in disease activity (ie, synovitis) and damage (ie, erosions). These imaging modalities are likely to be increasingly used in the management of early rheumatoid arthritis to ensure the best patient outcomes, although more work is required to determine their optimal roles.
15498797 Primary Sjögren's syndrome: new clinical and therapeutic concepts. 2005 Mar Sicca features are the central clinical manifestations of Sjögren's syndrome (SS), but recent studies have confirmed that primary SS has a systemic expression, including extraglandular manifestations. Patients with a predominantly extraepithelial expression should be managed differently from patients with predominantly periepithelial or sicca limited disease. In coming years treatment will be based on muscarinic agonists for sicca features and immunosuppressive/biological agents for extraglandular features.
16125918 Clinical aspects of rheumatoid arthritis. 2005 Oct Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology affecting both articular tissues and extraarticular organs. The disease is often progressive and results in pain, stiffness, and swelling of joints culminating in significant morbidity and increased mortality. This chapter discusses the epidemiology, possible etiology, clinical manifestations, diagnostic approach and treatment options of RA.
18088800 Dealing with the effects of juvenile rheumatoid arthritis in growing children. 2005 Nov Juvenile rheumatoid arthritis is a chronic childhood disease that has a multiplicity of effects on the growth and development of the facial skeleton. An understanding of the disease in general and its therapy is necessary for successful surgical-orthodontic care.
16735873 Lipopolysaccharide found in aseptic loosening of patients with inflammatory arthritis. 2006 Oct Aseptic loosening of orthopaedic implants occurs in the absence of clinical signs of infection. Nevertheless, bacterial endotoxins derived from subclinical infections, systemic sources, or the implant manufacturing process may contribute to aseptic loosening. Also, the rate of implant infection is greater in patients with inflammatory arthritis than in patients with osteoarthritis. We hypothesized that lipopolysaccharide, the classic endotoxin derived from gram-negative bacteria, is more prevalent in periprosthetic tissue surrounding aseptically loose implants in patients with inflammatory arthritis than in patients with osteoarthritis. To test this, we used a modified Limulus amebocyte assay not affected by beta-glucan-like molecules in mammalian tissues. Lipopolysaccharide rarely was detected in periprosthetic tissue from patients with osteoarthritis and aseptic loosening (one of six patients). In contrast, lipopolysaccharide was detected despite the absence of any clinical signs of infection in peri-prosthetic tissue from all four patients with inflammatory arthritis (rheumatoid arthritis, juvenile rheumatoid arthritis, and systemic lupus erythematosus). Lipopolysaccharide also was detected in two patients with gram-negative infections, who were included as positive control subjects. Endotoxins derived from low-grade or systemic bacteremia may be important contributors to aseptic loosening particularly in patients with autoimmune conditions such as inflammatory arthritis.
27144962 Arthritis -The Complete Guide to Relief Using Methods that Really Work Klein Arthur C Arth 2006 Jul 26 This guide for people living with rheumatoid arthritis or osteoarthritis aims to share with the reader what help people have accessed and what aspects of management, including conventional and complementary treatment, they have found beneficial or unhelpful.
16703818 Use of the faces pain scale to evaluate pain of a pediatric patient with pauciarticular ju 2006 Apr The Faces Pain Scale developed by Wong and Baker is a common assessment tool that uses cartoon-like faces to assess self reported pain in children. The purpose of this case report is to explore the appropriateness of the Faces Pain Scale as an outcome measure for a young child with pauciarticular juvenile rheumatoid arthritis. The patient was a four-year-old boy who had undergone a synovectomy on his right knee secondary to pauciarticular JRA. Each session the patient was asked to rate his pain using the Faces Pain Scale. The patient gainedfull knee range of motion and his functional mobility improved compared to initial visit. His subjective pain rating remained constant at "no hurt" throughout three weeks of visits. His functional mobility did not match his subjective rating of pain via the Faces Pain Scale. Further research is needed to determine the relationship of pain, stiffness, and function in children with rheumatic diseases.
15899064 Psoriatic arthritis synovial histopathology: commentary on the article by Kruithof and col 2005 The clinical features in psoriatic arthritis straddle the divide between rheumatoid arthritis on the one hand and spondyloarthropathy on the other. The paper by Kruithof and colleagues compares synovial immunohistologic features and clearly identifies psoriatic arthritis as being a member of the spondyloarthropathy family.
16284916 Population pharmacokinetics of the active metabolite of leflunomide in pediatric subjects 2005 Aug Leflunomide is a pyrimidine synthesis inhibitor used in the treatment of rheumatoid arthritis. Data from two clinical studies were used to establish a population pharmacokinetic (PPK) model for the active metabolite (M1) of leflunomide in patients with juvenile rheumatoid arthritis (JRA) and determine appropriate pediatric doses. Seventy-three subjects 3-17 years of age provided 674 M1 concentrations. The PPK model was derived from nonlinear mixed-effects modeling and qualified by cross-study evaluation and predictive check. A one-compartment model with first-order input described M1 PPK well. Body weight (WT) correlated weakly with oral clearance (CL/F = 0.020.[WT/40](0.430)) and strongly with volume of distribution (V/F = 5.8.[WT/40](0.769)). Steady-state concentrations (C(ss)) of M1 in JRA were compared for a variety of leflunomide dose regimens using Monte-Carlo simulation. To achieve comparable C(ss) values in pediatric patients with JRA to that in adult patients, doses of leflunomide should be adjusted modestly: 10 mg/d for 10-20 kg, 15 mg/d for 20-40 kg, and 20 mg/d for > 40 kg.